Since the late 1990s, the International Contact Lens Prescribing Survey Consortium has prospectively gathered information about 285,000 contact lens fits from more than 50 countries. This article presents our 14th annual summary of current trends published in Contact Lens Spectrum.

With only minor differences in the distribution of our surveys among markets, we have continued to adopt the same approach throughout the past 18 years. Through national coordinators, we approach contact lens prescribers in each country and ask them to record information about the first 10 patients whom they fit with contact lenses after receipt of our survey form. The information collected is generic, and respondents are weighted to reflect the volume of contact lens fits undertaken by each. For this 2014 report, we present information about 25,179 contact lens fits from 32 countries.

Lens Wearer Demographics

Table 1 shows that 69% of contact lenses were prescribed to females in 2014, a value that has remained remarkably constant since the inception of this project in 1996. In fact, females account for the majority of contact lens fits in all countries assessed except for Spain.

Table 1. Demographic information for the 32 countries surveyed.

Country

Total fits

Mean (±SD) age

% female

% new fits

% part time (≤3 days)

Argentina (AR)

170

38.6 ± 17.2

59%

49%

5%

Austria (AT)

350

35.3 ± 14.5

64%

25%

1%

Australia (AU)

489

37.4 ± 16.2

65%

42%

22%

Bulgaria (BG)

620

28.4 ± 9.3

74%

56%

4%

Canada (CA)

723

34.7 ± 15.9

67%

36%

14%

Switzerland (CH)

245

37.8 ± 14.4

61%

31%

10%

China (CN)

610

27.4 ± 6.0

80%

19%

8%

Czech Republic (CZ)

323

30.1 ± 14.3

67%

54%

23%

Germany (DE)

296

39.5 ± 16.2

68%

20%

7%

Denmark (DK)

384

38.1 ± 15.8

63%

35%

2%

Spain (ES)

569

33.0 ± 13.8

48%

55%

11%

France (FR)

1140

36.2 ± 15.8

69%

43%

6%

Greece (GR)

345

32.9 ± 11.6

57%

33%

15%

Hungary (HU)

228

29.3 ± 12.7

65%

50%

13%

Israel (IL)

779

29.0 ± 11.1

62%

30%

6%

India (IN)

150

28.8 ± 8.4

68%

63%

13%

Japan (JP)

4071

31.0 ± 14.6

68%

40%

15%

Lithuania (LT)

424

28.6 ± 10.7

69%

18%

16%

Mexico (MX)

684

28.6 ± 10.9

63%

41%

4%

Malaysia (MY)

686

29.8 ± 10.7

77%

28%

8%

Netherlands (NL)

969

36.2 ± 16.3

65%

30%

4%

Norway (NO)

643

37.0 ± 15.8

60%

32%

6%

Nepal (NP)

179

24.7 ± 9.3

58%

99%

0%

New Zealand (NZ)

677

38.6 ± 36.3

64%

36%

13%

Philippines (PH)

5205

27.5 ± 9.1

78%

28%

3%

Portugal (PT)

226

31.3 ± 12.5

69%

56%

8%

Russia (RU)

643

26.9 ± 10.4

54%

37%

4%

Sweden (SE)

506

38.1 ± 15.2

67%

29%

12%

Slovenia (SI)

130

33.7 ± 15.1

60%

44%

3%

Taiwan (TW)

1049

26.9 ± 10.9

82%

8%

0%

United Kingdom (UK)

852

39.1 ± 16.8

66%

45%

21%

United States (US)

814

36.9 ± 16.2

64%

25%

5%

Overall

25179

31.7 ± 14.8

69%

32%

7%

We are seeing more variation in age at fitting. The world average is close to 32 years, but it tends to be younger in some of the Asian markets (for example, 24.7 years in Nepal and 27.4 years in China) and is much older in Europe (39.1 years in the United Kingdom and 39.5 years in Germany).

Most fits are to existing wearers (i.e., “refits”) with new fits accounting for only 32% of lens wearers. Although some markets have modest proportions of part-time lens wearers (i.e., three days per week or less), including the Czech Republic, Australia, and the United Kingdom with 21% to 23% of wearers, overall contact lens fits are dominated by full-time wearers, with 93% of fits to patients scheduled to use contact lenses at least four times per week.

GP Lenses

Standard GP contact lenses account for 20% or more of lens fits in five countries studied: Argentina, Austria, France, the Netherlands, and Slovenia; the overall global average is 7% (Table 2). The data for the Netherlands are further supplemented by a remarkable 10% of all contact lens wearers who are prescribed orthokeratology lenses. No other market reaches more than 3% of all fits for this lens modality. Orthokeratology has a long history of strong use in the Netherlands, where the majority of practices are trained to undertake it. The popularity may result from a high level of education in this area combined with high-quality local manufacturers.

Table 2. Breakdown of all lens fits into seven key categories of lenses. See Table 1 for country abbreviations.

Country

Rigid (non OK)

OK

DD hydrogel

DD SH

Other DW hydrogel

Other DW SH

Soft EW

AR

26%

0%

1%

0%

34%

32%

6%

AT

38%

2%

5%

3%

16%

36%

0%

AU

6%

2%

15%

24%

7%

43%

5%

BG

9%

0%

3%

4%

6%

71%

8%

CA

10%

0%

13%

15%

10%

49%

2%

CH

16%

1%

12%

4%

41%

24%

1%

CN

4%

0%

19%

6%

47%

19%

5%

CZ

0%

0%

10%

19%

7%

57%

8%

DE

15%

2%

6%

9%

13%

52%

2%

DK

4%

0%

40%

11%

13%

23%

9%

ES

7%

3%

12%

1%

57%

18%

1%

FR

20%

2%

6%

10%

5%

57%

1%

GR

6%

0%

9%

3%

21%

55%

6%

HU

14%

0%

15%

12%

12%

40%

6%

IL

4%

0%

27%

11%

25%

28%

5%

IN

6%

0%

12%

2%

28%

50%

3%

JP

18%

0%

30%

10%

18%

23%

0%

LT

0%

0%

16%

6%

7%

46%

25%

MX

3%

0%

9%

0%

12%

74%

2%

MY

4%

2%

11%

6%

33%

25%

19%

NL

20%

10%

4%

5%

10%

49%

1%

NO

5%

1%

23%

17%

9%

20%

25%

NP

1%

0%

0%

0%

93%

0%

6%

NZ

19%

1%

14%

15%

9%

38%

3%

PH

1%

0%

2%

1%

54%

31%

12%

PT

3%

0%

12%

10%

15%

59%

1%

RU

2%

1%

11%

9%

18%

51%

9%

SE

2%

1%

22%

11%

5%

43%

15%

SI

44%

0%

3%

4%

5%

43%

0%

TW

2%

3%

50%

1%

42%

3%

0%

UK

5%

0%

17%

23%

6%

45%

4%

US

9%

0%

9%

15%

13%

49%

5%

Overall

7%

1%

12%

6%

31%

35%

7%

We noted 196 scleral lenses prescribed across the survey in 2014. This represents an increase of 15% since 2013, although scleral lenses still account for less than 0.1% of all contact lens fits reported.

High-Dk materials are the most commonly prescribed for standard GP contact lenses (Table 3). Spherical lenses are the most widely fitted GP lens design, with torics, multifocals/monovision, and orthokeratology lenses each representing about 13 percent of GP fits. About half of all GP lenses are prescribed on a planned replacement schedule.

Soft Lenses

Soft lenses account for 91% of contact lens fits (Table 4). Silicone hydrogels are the most widely used material of the four soft lens categories studied (49%), although a review of recent years suggests that the rapid increase of silicone hydrogel lens use observed since the start of the century has now reached a plateau. The use of silicone hydrogels varies considerably around the world, from more than 80% of soft lens materials in Bulgaria and France to less than 10% in Taiwan and Nepal (Figure 1).

Table 4. Detailed information for all prescribed soft lenses for markets reporting >100 soft lens fits. See Table 1 for country abbreviations. The final row indicates the proportion of multifocal and monovision lenses prescribed when patients were over 45 years of age.

Toric lenses account for 20% of all soft lens fits, with this number increasing to about 25% if monovision, multifocal, and cosmetic tinted lenses are excluded from this analysis (Figure 2) (i.e., we assess the proportion of toric lens fits to the overall number of torics and spheres). This value falls short of the expected 35% of fits if all patients who have 1.00DC of astigmatism or greater are prescribed toric contact lenses, or around 45% if those who have 0.75DC are included. Again, we see great variation in this metric around the world, with torics reaching 50% or greater of combined sphere/toric lenses in Austria, Argentina, Switzerland, and Mexico and fewer than 10% of fits in Lithuania, Taiwan, and Nepal.

Figure 2. Toric contact lens fitting as a proportion of spherical and toric contact lenses prescribed. See Table 1 for country abbreviations.

Figure 3 outlines the increase in soft toric lens prescribing in seven major markets since 2000. For most markets, there has been an approximate doubling in the proportion of toric lenses prescribed, presumably reflecting better soft toric performance and increasing practitioner confidence; the exception here is Japan, where toric prescribing has remained historically low.

Daily disposable lenses accounted for 22% of soft lens fits in 2014, although this proportion tended to be much higher in northern Europe, Japan, Taiwan, and Australia. Despite the relatively recent introduction of daily disposables manufactured from silicone hydrogel materials, there has been quick uptake of such lenses. We noted 11 countries in which most of the daily disposables prescribed were silicone hydrogels; in five markets (Austria, Czech Republic, France, Slovenia, and the United States), more than 60% of daily disposables were in this material category.

Overall, monthly replaced lenses were the most widely prescribed replacement schedule at 47%, with only 1% of soft lenses fitted on an “unplanned” replacement basis. Contact lenses for extended wear remain rarely prescribed (8% of both new fits and refits), usually with silicone hydrogel materials. As in previous years, Norway (28% of new fits into extended wear) and Lithuania (20%) are significant outliers from the normal practice for this modality. CLS

The authors acknowledge the administrative support of Eurolens Research and the Centre for Contact Lens Research at the University of Waterloo, Canada.

Southeast and East Asia

Data for the Philippines was recorded for the first time in 2014, with a large return of 5,205 contact lens fits; information was also gathered for Malaysia after an absence of some years. Figure 4 shows summary results for these markets alongside other markets in the southeast and east Asia region, with some clear differences apparent. Very few GP or daily disposable lenses are prescribed in the Philippines compared with other regional markets, such as Japan (high GP prescribing) and Taiwan (high daily disposable prescribing). Malaysia shares some similar prescribing trends with the Philippines, including a relatively high rate of extended wear prescribing.